John G. Neihardt Foundation Membership Application

Please find enclosed my check payable to The John G. Neihardt Foundation for:
(Please check appropriate box)

$25.00 For Individual Annual Membership

$30.00 For Couple or Family Annual Membership

$500.00 Life Membership paid at rate of $100 per year

$_______ Contribution

Name _____________________________________________________________

Address ________________________________________

P.O. Box No. _________________

City _____________________________________ State _____________

Zip _____________

Mail to:
           JOHN G. NEIHARDT FOUNDATION, INC
           P.O. BOX 344
           BANCROFT, NE 68004-0126

Thank you!